Basic Information
| Provider Information | |||||||||
| NPI: | 1770627077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLTON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| OtherLastName: | CARLTON | ||||||||
| OtherFirstName: | GREGORY | ||||||||
| OtherMiddleName: | T | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 760 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | RUSH CITY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550699063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519827966 | ||||||||
| FaxNumber: | 3203584665 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 RIVERSIDE AVE | ||||||||
| Address2: | FCO-4 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126726000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2007 | ||||||||
| LastUpdateDate: | 04/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 30076 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.